Historic Cemetery • Annual Monitoring Form

Please email grants@nullpreservewa.org or call 206-462-2999 if you have any questions.

Cemetery Name
County
Cemetery Address
Street Address City State ZIP Code
Grant Cycle in which Funds were Awarded
Owner's Name
First Last
Phone
Email
Owner's Mailing Address
Street Address City State ZIP Code
Describe any changes, alterations, new building/features to the cemetery in the last year.
For example: was a columbarium built or a fence replaced?
If changes have been made, did you contact program staff prior to implementing the changes?*
- Yes
- No
- N/A (did not make changes)
Describe any damage the cemetery incurred in the last year, noting the cause of damage.
Describe any anticipated changes or projects in upcoming year.
Program staff will request more information if necessary, but it is still your responsibility to contact staff before any significant projects begin that will impact the cemetery within the 10-year maintenance agreement period.
Photo Documentation
Please submit photos illustrating all sides of the barn. If changes or alterations have been made to the barn, include additional images illustrating these changes. Please label photo file names.
Drop files here or

Max. file size: 50 MB.
Submission*
- I hereby acknowledge that the information provided in this form is complete and accurate.
Today's Date*
MM slash DD slash YYYY